ABSTRACT
OBJECTIVES: Gallstone diseases impose a significant economic burden on the health care system; thus, determining cost-effective management for gallstones is essential. We aim to estimate the cost-effectiveness of cholecystectomy compared with conservative management in individuals with uncomplicated symptomatic gallstones or cholecystitis in India. METHODS: A decision-analytic Markov model was used to compare the costs and QALY of early laparoscopic cholecystectomy (ELC), delayed laparoscopic cholecystectomy (DLC), and conservative management (CM) in patients with symptomatic uncomplicated gallstone/cholecystitis from an Indian health system perspective. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were performed to test parameter uncertainties. RESULTS: ELC and DLC, compared to CM, incurred an incremental cost of -â¹10,948 ($146) and â¹1,054 ($14) for the 0.032 QALYs gained. The ICER was -â¹3,42,758 ($4577) for ELC vs. CM, and â¹33,183 ($443) for DLC vs. CM, suggesting ELC and DLC are cost-effective. ELC saved â¹12,001 ($160) for 0.0002 QALYs gained compared to DLC, resulting in an ICER of -â¹6,43,89,441 ($8,59,733). The results were robust to changes in the input parameters in sensitivity analyses. CONCLUSION: ELC is dominant compared to both DLC and CM, and DLC is more cost-effective than CM. Thus, ELC may be preferable to other gallstone disease managements.
Subject(s)
Cholecystitis, Acute , Cholecystitis , Gallstones , Humans , Gallstones/surgery , Cost-Benefit Analysis , Cholecystitis, Acute/surgery , Conservative Treatment , Treatment Outcome , Cholecystitis/surgery , Cholecystectomy , IndiaABSTRACT
BACKGROUND: The effectiveness of early cholecystectomy for gallstone diseases treatment is uncertain compared with conservative management/delayed cholecystectomy. AIMS: To synthesise treatment outcomes of early cholecystectomy versus conservative management/delayed cholecystectomy in terms of its safety and effectiveness. DESIGN: We systematically searched randomised control trials investigating the effectiveness of early cholecystectomy compared with conservative management/delayed cholecystectomy. We pooled the risk ratios with a 95% CI, also estimated adjusted number needed to treat to harm. RESULTS: Of the 40 included studies for systematic review, 39 studies with 4483 patients are included in meta-analysis. Among the risk ratios of gallstone complications, pain (0.38, 0.20 to 0.74), cholangitis (0.52, 0.28 to 0.97) and total biliary complications (0.33, 0.20 to 0.55) are significantly lower with early cholecystectomy. Adjusted number needed to treat to harm of early cholecystectomy compared with conservative management/delayed cholecystectomy are, for pain 12.5 (8.3 to 33.3), biliary pancreatitis >1000 (50-100), common bile duct stones 100 (33.3 to 100), cholangitis (100 (25-100), total biliary complications 5.9 (4.3 to 9.1) and mortality >1000 (100 to100 000). CONCLUSIONS: Early cholecystectomy may result in fewer biliary complications and a reduction in reported abdominal pain than conservative management. PROSPERO REGISTRATION NUMBER: 2020 CRD42020192612.
